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Fiber tracking, fMRI of ependymoma

Case Study
White, Matthew, M.D. Omaha, Nebraska, The Nebraska Medical Center USA
Van Tilburg, Jeremy, RT, (R), (CT), (MR) Omaha, Nebraska, The Nebraska Medical Center USA

This MR examination was performed at The Nebraska Medical Center using Achieva 3.0T X-series at release 2.5, where the ExamCard synchronizes Eloquence's* paradigms and the MR scanning.

 

*Eloquence is not licensed for sale in Canada.

Patient history:

39-year-old female who began having strange twitching sensations in her right epigastric area which migrated towards her right shoulder and arm. She then subsequently had episodes of involuntary shoulder and arm twitching which were self-limited.

 

She was evaluated and on the imaging studies was found to have a cystic and solid mass which was thought to be in the anterior left parietal area, in the area of the central sulcus. She was having difficulty utilizing her right hand for some fine motor tasks such as grabbing small things and buttoning her shirt.

 

On physical exam her strength in all muscle groups is symmetric and full throughout.

MR examination:

The 8-channel SENSE Head coil is used with the fMRI hood.

 

The ExamCard used was designed for use with the Invivo Eloquence fMRI system. Paradigms included are Visual motor, Word Generation, Auditory, Verb generation, Right and left hand finger tapping, Left and right foot, as well as Lip.

 

The ExamCard included:

3D T1 sagittal, 1x1x1 mm resolution, scan time 5:57 min.

All fMRI paradigms were performed, total scan time 5:15 min.

Axial FLAIR isometric, 1x1x1 mm resolution, scan time 5:00 min.

DTI_2x2x2 mm resolution, scan time 6:36 min.

Images:

This is a tractogram of the right corticospinal tracts, that are shown to lie at the inferior aspect of the tumor and to be deviated posteriorly. Also, being deviated posteriorly are sensory fibers from the parietal lobe. The DTI tractogram is superimposed upon a T1 FFE image.

 

 

This is fMRI of right finger tapping. The activation is noted to abut the lateral aspect of the tumor which is shown by the T1 FFE images to be centered in the motor strip.

Diagnosis:

Ependymoma, grade II.

Clinical impact of these MR results:

Our MRI results demonstrated the mass to be in the motor strip with the right hand function lateral to the mass and corticospinal tracts to about the inferior surface of the mass.

 

After reviewing these results, the neurosurgeon decided to convert the surgery to an awake case with intraoperative sensory mapping. Post-operatively the patient was neurologically intact and the tumor judged at operation to have had a gross total resection. The post-operative MRI showed a complete resection.



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Case Study
Achieva 3.0T X-series
Release 2.5
Quasar, Quasar Dual
3T, Brain, Neuro
 

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